Key issues and models of good practice in assisting people with learning disabilities to gain employment in mainstream companies

  9 
 Learning disability  is the most common term used in European English to define what in other areas (e.g. 
North America) is termed  mental retardation . Both the terms refer to an intellectual impairment which is the 
main cause of people being unable   to perform an activity in the manner or within the range considered 
normal for a human being   (World Health Organisation, 1980, p. 143). 
 Open employment  refers to companies where the proportion of employees with disabilities does not usually 
exceed that in the general population.  
Although the purpose of this study is to present qualitative findings about job-matching/supported 
employment provider agencies, quantitative aspects are taken into account in considering some aspects of the 
organisations. The study does not involve a comparative analysis of the efficacy of the four organisations 
studied because of the considerable legislative, economic, political and cultural differences between their 
operational context/settings. This research is intended to present examples of good practice, but it also 
provides a framework of key elements as a tool for analysing and comparing practice. 
This report contains 10 chapters. The first shows some theoretical suggestions supporting the idea of people 
with learning disabilities working in mainstream companies and also it presents an overview on the American 
model of Supported Employment. The second chapter presents the methodology adopted in carrying out the 
empirical aspects of the research. The third and the fourth chapters provide contextual information on 
employment legislation for people with disabilities and some statistics. The core of the study is the analysis 
of the strategies adopted by four provider agencies devoted to job-matching/supported employment and the 
identification of a framework of key elements that characterises the strategies and models of good practice. 
Chapters five to nine illustrate these results. Conclusions and recommendations end the report. 
  10 













 
 
The following sections look at three varied points of views on social exclusion. These 
contributions are not directly related to disability issues, but were selected because they 
permit a fundamental move away from the heuristic of disability, in order to study 
exclusion as a general social problem. 
1.1. CULTURAL ASPECTS 
Geertz (1993) refers to an Edgerton article on different perceptions of indeterminate 
sexuality, held by different cultures. The modern American culture is totally disoriented on 
how to deal with diversity. It encourages people of indeterminate sex to assume a male or a 
female persona and makes them attempt to look as normal as possible in order not to hurt 
the feelings of the  normal people . The Navajo population also perceives this condition as 
an abnormal phenomenon. However, to them, it causes astonishment and reverential fear. 
It is considered a blessing from God to the individual and to others as well. Such people 
are respected and revered as leaders carrying richness to the community. In Africa, the 
Pokot tribe s attitude is different from the previous two, though there are also some 
similarities. Like the Americans, Pokots do not hold these people in high regard. However 
they do not feel horror or revulsion either. They just consider such individuals a mistake. 
Sometimes, as children, they are killed, other times not. The choice is totally casual. When 
adult they are treated with indifference; people do not care about them, although they are 
often economically prosperous without a family to support. Geertz concludes with:  God 
may have made the intersexuals, but man has made the rest  (Ibid, p.84).  
In a similar way different cultural patterns may have different influences on the lives of 
people with disabilities. Often their limitations are overestimated and magnified. They are 
denied opportunities to develop skills or good social behaviour because of a culture which 
is prejudiced against diversity. Exclusion may begin in the first days after their birth. Often 
the family of a person with a disability initially cannot accept the difference, and neither 
can the wider circle of relatives and friends. Even where the family is ready to accept the 
child s difference, the culture may work against their wishes. 
  11 
In this regard some parents  experiences cited in Breda and Rago (1991, p.35-36; as 
translated by the author) are most significant.  ...it was terrible, I felt it as a life sentence. I 
was waiting for him to be brought to me then, I was telling myself,  I would have thrown 
him through the window...   
 ...my husband used to play with our baby girl at home, but he did not want to bring her 
out. He was ashamed...  
 ...of course , I felt this baby girl as a failure. But nobody helped me to feel differently 
about her at that time; we all wish to have nice, healthy, intelligent sons when we decide to 
become mothers. This is the culture in which people grow up, it is hard to be free of it, 
because there is always someone there to remind  you...   
 ... the doctor told us that he was an untidy child, that he was not able to understand and 
that it would had been a waste of time to send him to school because he would not have 
learnt anything. Then he suggested we  put him in an Institute...   
Initial parental feelings in response to the birth of a baby with impairments may be very 
strong and negative. Later it may became milder, sometimes the negative feeling 
completely disappears. However, very often children with impairments have to face more 
difficulties than their peers, as they grow up. They have to cope with the limitations that 
arise from the impairment itself and, in addition, with the negative connotations with 
which they are introduced to other people and to institutions. 
 
1.2. THE ROLE OF SOCIALISATION PROCESSES 
Berger and Luckman (1966) stated that people became effective members of society only 
after taking sequential steps to internalise objective reality. These steps are part of a 
continuum, which globally is named socialisation. In the first period of life, in infancy and 
early childhood, primary socialisation occurs. In later developmental stages secondary 
socialisation takes place. During primary socialisation people have a low level of physical 
and emotional autonomy. They depend totally on relationships emotionally conditioned by 
a small circle of adults. In this time they build their main framework of identity. 
Consequences of primary socialisation are very persistent and they will influence people s 
adult lives. 
When adults are involved in the socialisation process, it is called secondary socialisation. 
  12 
This refers to the necessity to learn the different roles to be played in modern societies. 
Relationships are less emotionally conditioned and the consequences of this socialisation 
are less persistent than in the primary one.  
The strong persistence of the outcomes of primary socialisation offers benefits in term of 
emotional stability for people. It is a support in orientating them in their future social life, 
and when difficulties occur. However, at the same time, it can be a disadvantage since, 
when primary socialisation has been damaged, it is not easy to make changes.   
As discussed in the first part of this chapter, relationships between children with 
disabilities and adults (parents, relatives, family friends, educational institutions, 
sometimes medical specialists as well) are often conditioned by a negative perception of 
their difference. Often they are perceived as sick and as a result are excluded from the 
usual chances available to their peers to develop a balanced primary socialisation. As a 
consequence, they miss out on a wide range of opportunities, which increases the 
disadvantage already caused by their congenital impairment. Recovering from this deficit 
in socialisation is not always easy, sometimes it is not even possible. 
 
1.3. SOCIALISATION AND ILLNESS  
The approach adopted by Giori (1984) about old age and society seems to be pertinent for 
this study. Even though his field of interest differs from the concern of the current 
research, his perspective can provide interesting insights. He believed that what is termed 
 old-age illness  (a reaction to ageing brought about by assimilating the stereotype of old 
age) is more often influenced by social factors than by simply growing old. Reduced 
opportunities for social interaction, not infrequent at retirement age, may lead to a general 
individual indisposition such as the person feeling sick even when the clinical picture has 
not suffered any alterations. The proposal by Giori, which obviously represents only a 
generalisation of the phenomenon, is presented in graph 1. 
 
 
 
 
 
 
Graph 1. Physiological deterioration, socialisation and illness area. 
 
  13 
 
 (Source: Giori, 1984) 
 
 
 
S o c ia lisa tio n
factors curve
  14 
After the working age (retirement age on x-axis), the curve of physiological deterioration 
progresses up caused by the natural, biological, growing old. The curve of socialisation 
factors progresses down caused by the loss of work-related social interactions. The hatched 
area beyond point G represents the prevalence of the physiological deterioration over the 
socialisation factors, i.e. the prevalence of the stereotype of  old-age illness . 
Giori suggested that a reinforcement of the friends/relationships network after retirement 
age, would lead to a weaker drop in the socialisation factors curve and, as a consequence, a 
delay in the progress of the physiological deterioration. As an outcome, the area of old-age 
illness would be more restricted and delayed as shown in graph 2. 
  15 
 
Graph No. 2: Physiological deterioration, socialisation and illness area after re-socialisation .  
 
 
(Source: Giori, 1984).   
 
The same considerations could be applied to the stereotyped  disability-illness . A main distinction is that in 
this case we do not refer to the retirement age, but to the working age even if characterised by lack of 
working experiences. The physiological deterioration curve will depend on the degree to which the subject 
with disabilities perceives him/herself to be ill. Often, in fact, his/her family and the outcomes of his/her 
socialisation may exacerbate perception of self as sick. The socialisation factors curve will be low if the 
subject experiences social isolation such as poor friendships and segregating activities. By substituting these 
considerations in graph 2 it is possible to predict a wide area of  disability-illness . However it should be 
possible to reduce the size of the area by re-socialisation strategies, influencing the physiological 
deterioration curve (disability) which could be lowered from its original level. 
It is important to point out that while assigning reasons for the extension of the  illness 
area  to the complex interaction between physiological and social factors, it is not implied 
that illness does not exist. Rather, it is intended that the  illness area  could be over-
represented in reference to the real potential condition of the person. 
 
Re-socialisation curve
Physiological
deterioration curve
    Old-age Illness area
    after re-socialisation
      G’
           G
Socialisation
factors curve
Retirement age Death age
Effect of re-socialisation on
physiological deterioration curve
 
  16 
1.4. THE DEFINITION OF  HANDICAP  BY THE WORLD HEALTH ORGANISATION 
The definitions of impairment, disability and handicap by the World Health Organisation 
(World Health Organisation, 1980) provide further insight into the role played social 
context on the degree of  handicap  a person may experience. The definitions are as 
follows:  
Impairment is   any loss or abnormality of psychological, physiological, or anatomical 
structure or function impairment may be temporary or permanent it represents an 
exteriorisation of a pathological state  (World Health Organisation, 1980, p. 47). 
Disability is   any restriction or lack (resulting from an impairment) of ability to perform 
an activity in the manner or within the range considered normal for a human 
being Disability represents objectification of an impairment, and as such it reflects 
disturbances at the level of the person  (ibid, p. 143). 
Handicap is   a disadvantage for a given individual, resulting from an impairment or a 
disability, that limits or prevents the fulfilment of a role that is normal (depending on age, 
sex, and social and cultural factors) for that individual Handicap thus represents 
socialisation of an impairment or disability   (ibid., p. 182). 
In other words disability originates as a pathological state. Externally this may be manifested in some 
impairment, which causes a functional disability. The functional disability may lead to a handicap or not. 
This may be big or small, depending on the social context. Figure 1 provides an example of relations between 
impairment, disability and  handicap . 
 
 
 
 
  17 
 
Definitions: Example:
Pathological state Spine injury
Impairment Loss of use of legs
Disability Walking difficulty
Handicap Mobility failure depending
on extent of barriers
 
 
Figure 1: example of relation between impairment, disability and  handicap . 
 
The figure 1 shows the case of a person whose pathological state consists of a spine injury, resulting into the 
loss of use of legs (impairment) which in turn determines walking difficulties (disability). While impairment 
and disability are directly originated from the personal condition of the person (his/her pathological state), the 
person s  handicap  depends on external factors. For example the person may be seriously handicapped 
because he/she cannot get around; however, a wheelchair may make him/her less handicapped. Despite 
having a wheelchair, he/she may be handicapped if buildings do not have ramps or lift. Even if wheelchair 
and ramps are available he/she might be handicapped if, for example, employers discriminate against 
him/her. Wheelchairs, ramps, lifts and non discriminating attitudes are originated from externally the person 
with disability since they depend on social and cultural factors, as indicated by the World Health 
Organisation. 
The same reasoning may be extended to all other type of disabilities (physical, sensorial or intellectual), 
which may engender a handicap, the nature and the degree of which depends on the social context. In the 
case of a person with learning disability, for instance, inadequate training or cultural barriers may engender 
the exclusion of such a person from open employment even if his/her potential working skills are suitable for 
a job.  
 
1.5. PRELIMINARY CONSIDERATIONS 
It is necessary to consider why the implementation of anti-discriminatory declarations and 
  18 
legislation has had wicked success. Geertz commented:  God may have made the 
intersexuals, but man has made the rest  (1993, p. 84).  Something similar could be said 
for people with disabilities. They also have to face the effects of the cultural environment 
in which they have the good or bad fortune to be born.  
Berger, Luckmann and Giori s theories may help in predicting the effectiveness of 
employment practices. For example, their contributions on the consequences of primary 
socialisation suggest that the same impairment does not necessarily lead to the same level 
of disability, since very much depends on the opportunities a person has had in his/her 
earlier life to develop self-esteem and social skills.  
Giori provides arguments in support of the suggestion that the field of  disability-illness  
may be reduced, since sometimes it is  over-represented  as a consequence of lack of 
socialisation opportunities. However the amount of achievable reduction is not predictable 
and the disability-illness field, even when reduced, may still be considerable.  
As a conclusion, it seems that the exclusion of people with disabilities from employment is 
part of a complex interplay of phenomena. Provider agencies, operating with the approach 
 place then train , seem to play an interesting mediation role between the world of people 
with disabilities and that of employers. The  place then train  approach can contribute to 
the recovery of damaged socialisation through make it possible for people with disabilities 
to experience community integration in the employment dimension of their life. In this way 
the extent of  disability illness  may be reduced. At the same time provider agencies know 
well the labour market and its needs, so they can assist employers effectively when 
necessary.  
 
1.6 AN OVERVIEW ON THE AMERICAN EXPERIENCE IN PROMOTING EMPLOYMENT FOR 
PEOPLE WITH DISABILITIES  
Employment practices with the  place then train  approach have been operating 
simultaneously but independently in both Northern America (Rusch & Hughes, 1990) and 
in Europe (in Italy; Lepri & Papone, 1999), since the mid-1970s. However, it is in the 
former continent that a large amount of studies have been conducted in the field
2
. 
Moreover, the USA experience has played a major role in influencing most of the agencies 
                                                          
2
 A number of institutions are involved in research such as Virginia Commonwealth University, Institute for 
Community Inclusion - Children s Hospital Boston, University of Illinois, Temple University, University of 
Oregon, University of Georgia. 
  19 
studied in the current piece of research. For these reasons, although the focus of the current 
study is on the European experience, the following sections outline the approach in the 
USA, which is commonly called  supported employment . According to the Rehabilitation 
Amendments Act in 1992, the term  supported employment  means  competitive work in 
integrated work settings for individuals with the most severe disabilities for whom 
competitive employment has not traditionally occurred; or for whom competitive 
employment has been interrupted or intermittent as a result of a severe disability; and 
who, because of the nature and severity of their disability, need intensive supported 
employment services...and extended services to perform such a work  (§706[18][A], as 
reported by Parent, Cone, Turner and Wehman, 1998, p. 154)  
The following sections explore supported employment under the following headings: its 
philosophical basis, origin, related legislation, fundamental elements, main models, 
statistics and challenges for its future.  
1.6.1. Philosophical  issues  
Marc Gold
3
 played an important role among pioneers of supported employment. His 
philosophy lies in the belief that a person s lack of learning should be interpreted as  a 
result of inappropriate or insufficient use of teaching strategy, rather than inability on the 
part of the learner  (Gold, 1980 as reported by Henderson, 1990, p. iii). On this basis Gold 
developed the principle of  try another way  which led to the method of  systematic 
instruction . This procedure consists of breaking the tasks of a job into very simple steps, 
and establishing a teaching process starting from elementary operations, rather than from 
the  complex  original task (Test & Wood, 1997). Gold also underlined that lack of 
innovation in traditional rehabilitation programmes is often due to low expectations on the 
part of the rehabilitation system with regard to their clients  abilities (Ellis, Rusch, Tu and 
McCaughrin, 1990).  
Another important factor influencing the implementation of supported employment 
programmes is the philosophy of  normalisation  which was developed during the 1970s. 
Its principles include the requirement to deliver all services to people with needs through  
approaches, and under conditions, as  culturally normal  as possible. On the basis of this 
philosophy, establishment and maintenance of special services such as sheltered 
                                                          
3
 Marc Gold, while working part-time in his father s bike repair workshop, studied and gained bachelor and 
master degrees. He subsequently obtained a Ph.D. in special education at the University of Illinois. Before 
dying of cancer he developed and divulged his philosophy and methods aimed at improving occupations for 
  20 
workshops, adult day centres and institutions which segregate could no longer be justified 
(Rusch & Hughes, 1990). Moreover, in the late 1970s a number of studies gave evidence to 
the fact that people with learning disabilities, who usually were placed in sheltered 
workshops or day centres, could be successfully placed in competitive employment (Rusch 
& Hughes, 1990).  
The traditional approach, based on the medical model, was gradually changing from a 
philosophy of fixing/curing people with disabilities toward a perspective of giving people 
the necessary supports in order for them to access, in so far as possible, all dimensions of 
life (Wehman, 1998a). 
1.6.2. Origin and development of supported employment 
Within this evolution of the cultural context, some innovative projects attempted to 
implement the first community based services. In 1975, the University of Washington 
established programmes aimed at placing and training people with learning disabilities in 
food services (Rusch & Hughes, 1990). In 1978 the Virginia Commonwealth University 
(VCU), through a three year grant (Project Employability), formally started promoting the 
conversion of adult day centres for people with learning disabilities into services providing 
support and employment in mainstream companies. In 1981, another grant from the 
Federal Rehabilitation Services Administration was given to VCU in order to promote the 
implementation of the project in other areas of Virginia. In 1984, the Department of 
Rehabilitative Services (DRS) established a fee-based programme of supported 
employment involving VCU. In 1985 the VCU received a grant from the Federal Office of 
Special Education and Rehabilitative Services for the development of a state system of 
supported employment which was called Virginia Supported Employment Information 
System (VSEIS). It was mandatory for provider agencies who were funded by the 
Department of Rehabilitative Services (DRS) to participate in the programme through the 
submission of data on their activities. The goal of the information system was to provide 
figures for the management and evaluation of the general supported employment 
programme. Data collected included client s profiles, services provided, clients  work 
performance, outcomes, employment retention and causes of job-loss (Kregel, Wehman, 
Revell and Hill, 1990).   
Following the model designed by the University of Washington, the University of Illinois 
                                                                                                                                                                                
people with disabilities (Henderson, 1990).   
  21 
launched its first project aimed at employment of people with disabilities in 1978. In 1985, 
a supported employment programme was established by the state of Illinois with funding 
from the Department of Rehabilitation Services, the Governor s Planning Council on 
Developmental Disabilities and the Department of Mental Health and Developmental 
disabilities (Ellis et al., 1990). In Pennsylvania the implementation of supported 
employment programmes started in 1985. Unlike other states, however, where funding 
came from a number of different sources, in Pennsylvania financial resources were from a 
unique one at the state level (Vogelsberg, 1990). In the same years several projects of 
supported employment were launched in many other states. Before exploring some of the 
fundamental elements of supported employment and the figures of such development, the 
following sections describe some aspects of the legislative context. 
1.6.3. Related legislation 
During the 1980s supported employment programmes received the attention of the 
legislature. The Developmental Disabilities Assistance and Bill of Rights Act in 1984 
included and acknowledged supported employment among the programmes aimed at 
promoting employment for people with disabilities. It defined supported employment in 
terms of paid employment for people who, because of their disabilities, needed ongoing 
support. Employment was envisaged in settings with co-presence of employees without 
disabilities. In 1986, the Rehabilitation Amendments Act provided further guidelines such 
as a prescription of a minimum of 20 working hours per week, a formula for follow-up 
monitoring at least twice per month in the workplace and a provision that the maximum 
number of people with disabilities in group placements would be eight (for definition of 
group placement see section below on models of supported employment). In the same year, 
Congress agreed funding for pilot projects of supported employment in 27 states (Rusch & 
Hughes, 1990). In 1990, the Individual with Disabilities Education Act  (IDEA) made 
provisions so that the educational system extended its remit to the planning of student s 
transition to adulthood including supported employment as a means of transition. In the 
same year the American with Disability Act (ADA) made provisions in order to facilitate 
the employment of people with disabilities through anti-discriminatory recruitment 
practices and the enforcement of reasonable accommodations in the workplace (Thornton 
& Lunt, 1997). Finally, in 1992, the Rehabilitation Amendments Act confirmed the 
importance of supported employment. It  emphasised competitive work, integration in the 
workplace, the inclusion of beneficiaries with high level of disabilities and the adoption of 
  22 
ongoing support during employment (Wehman & Revell, 1997).  
1.6.4. Fundamental elements of supported employment 
The definition of supported employment by the Rehabilitation Amendments Act in 1992, 
implies a number of key elements. These will be briefly discussed under the following 
headings: employment specialists, targeted groups of consumers, consumer assessment, 
locating jobs, job placement arrangements, job-site training, ongoing support (or follow-
along services), clients  wages and their integration in the workplace.  
Employment specialists, or job coaches, play a major role since they deal with the above 
issues and make the actual employment of people with disabilities possible. (Wehman & 
Parent, 1996; Parent et al., 1998).  
Supported employment has been designed and aims to serve people with the most severe 
levels of disability, who could not otherwise find a job in the competitive workplace 
(Wehman & Parent, 1996).  
Through consumer assessment, employment specialists aim to gather as much information 
as possible on the candidates  abilities, desires and preferences. Assessment is usually 
based on some records, observation, informal time spent by the employment specialist with 
the candidate (e.g. lunch together or/and a number of visits in the most convenient places 
for the consumer), and interviews with key people who may possess significant 
information on the candidate.  
Employment specialists then locate the available jobs, taking into account the 
characteristics of the candidate and making sure that the expectations of both the employer 
and the candidate are met. 
Job placement arrangements include all the necessary preparations for the commencement 
of work. These would include assisting the candidate in his/her interview with the 
employer, negotiating work schedules and job-accommodation, advocating on behalf of the 
candidate, helping him/her to make acquaintances with co-workers and assessing the 
availability of possible support within the workplace.  
One of the peculiarities of supported employment is that candidates do not have to be 
ready for the job before actually starting it. In fact, the employment specialist provides job-
site training to the new employee with disability from his/her first day of work. In addition 
the employment specialist ensures that the work is completed as the employer expects it. It